Early Response Monitoring of Receptor Tyrosine Kinase Inhibitor Therapy in Metastatic Renal Cell Carcinoma Using [F-18]Fluorothymidine-Positron Emission Tomography-Magnetic Resonance

Valls, Laia; Hoimes, Christopher J.; Sher, Andrew; Hu, Lianghai; Lee, Zhenghong; Muzic, Raymond F.; Avril, Norbert

doi:10.1053/j.ro.2014.09.001

Cited by 5 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It would be of interest to directly compare changes in tumor metabolic activity with dynamic contrast enhancement or diffusion-weighted imaging. Future applications might include a combination of such parameters, as shown for other tumor entities (22). …”

Section: F-fdg Pet For Early Prediction Of Treatment Responsementioning

confidence: 99%

¹⁸F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

et al. 2016

Self Cite

View full text Add to dashboard Cite

Changes in tumor metabolic activity have been shown to be an early indicator of treatment effectiveness for breast cancer, mainly in the neoadjuvant setting. The histopathologic response at the completion of chemotherapy has been used as the reference standard for assessment of the accuracy of 18F-FDG PET in predicting a response during systemic treatment. Although a pathologic complete response (pCR) remains an important positive prognostic factor for an individual patient, a recent metaanalysis could validate pCR as a surrogate marker for patient outcomes only in aggressive breast cancer subtypes. For establishment of the clinical application of metabolic treatment response studies, larger series of specific breast cancer subtypes—including hormone receptor–positive, human epidermal growth factor receptor 2–positive, and triple-negative breast cancers—are necessary. In addition, thresholds for relative changes in 18F-FDG uptake to distinguish between responding and nonresponding tumors need to be validated for different systemic treatment approaches, with progression-free survival and overall survival as references. A PET-based treatment stratification is applicable clinically only if valid alternative therapies are available. Of note, patients who do not achieve a pCR might still benefit from neoadjuvant therapy enabling breast-conserving surgery. In the metastatic setting, residual tumor metabolic activity after the initiation of systemic therapy is an indicator of active disease, whereas a complete resolution of metabolic activity is predictive of a successful treatment response.

show abstract

Section: F-fdg Pet For Early Prediction Of Treatment Responsementioning

confidence: 99%

¹⁸F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

et al. 2016

Self Cite

View full text Add to dashboard Cite

show abstract

“…It has previously been shown that, in a comparison of feature reliability, ADC texture features have ranked higher than T2w features in demonstrating more consistent changes in healthy tissue regions [16] . In a previous case study that presented some of the data used in this work [38] , FLT-PET was shown to have an overall high repeatability (i.e., low variability) between test/retest studies. DWI-ADC was found to be less repeatable likely because of respiration artifacts affecting image quality, whereas T2w MRI and radiomic features were not evaluated.…”

Section: Resultsmentioning

confidence: 89%

Radiomics Analysis on FLT-PET/MRI for Characterization of Early Treatment Response in Renal Cell Carcinoma: A Proof-of-Concept Study

Antunes

Viswanath

Rusu

et al. 2016

Translational Oncology

Self Cite

View full text Add to dashboard Cite

Studying early response to cancer treatment is significant for patient treatment stratification and follow-up. Although recent advances in positron emission tomography (PET) and magnetic resonance imaging (MRI) allow for evaluation of tumor response, a quantitative objective assessment of treatment-related effects offers localization and quantification of structural and functional changes in the tumor region. Radiomics, the process of computerized extraction of features from radiographic images, is a new strategy for capturing subtle changes in the tumor region that works by quantifying subvisual patterns which might escape human identification. The goal of this study was to demonstrate feasibility for performing radiomics analysis on integrated PET/MRI to characterize early treatment response in metastatic renal cell carcinoma (RCC) undergoing sunitinib therapy. Two patients with advanced RCC were imaged using an integrated PET/MRI scanner. [18 F] fluorothymidine (FLT) was used as the PET radiotracer, which can measure the degree of cell proliferation. Image acquisitions included test/retest scans before sunitinib treatment and one scan 3 weeks into treatment using [18 F] FLT-PET, T2-weighted (T2w), and diffusion-weighted imaging (DWI) protocols, where DWI yielded an apparent diffusion coefficient (ADC) map. Our framework to quantitatively characterize treatment-related changes involved the following analytic steps: 1) intraacquisition and interacquisition registration of protocols to allow voxel-wise comparison of changes in radiomic features, 2) correction and pseudoquantification of T2w images to remove acquisition artifacts and examine tissue-specific response, 3) characterization of information captured by T2w MRI, FLT-PET, and ADC via radiomics, and 4) combining multiparametric information to create a map of integrated changes from PET/MRI radiomic features. Standardized uptake value (from FLT-PET) and ADC textures ranked highest for reproducibility in a test/retest evaluation as well as for capturing treatment response, in comparison to high variability seen in T2w MRI. The highest-ranked radiomic feature yielded a normalized percentage change of 63% within the RCC region and 17% in a spatially distinct normal region relative to its pretreatment value. By comparison, both the original and postprocessed T2w signal intensity appeared to be markedly less sensitive and specific to changes within the tumor. Our preliminary results thus suggest that radiomics analysis could be a powerful tool for characterizing treatment response in integrated PET/MRI.

show abstract

“…FLT PET allows evaluation of treatment response much earlier than FDG PET, even within the first week of therapy (36). Hybrid PET/MRI systems, which were recently introduced in clinical practice to assess treatment response of recurrence and solid organ metastases such as liver, are still used experimentally in many centers and have yielded encouraging results (37,38).…”

Section: -Fluorine-fluorothymidine Positron Emission Tomographymentioning

confidence: 99%

Positron Emission Tomography in Renal Cell Carcinoma

Soydal¹,

Ürün²

2018

uob

View full text Add to dashboard Cite

IntroductionRenal cell carcinoma (RCC) is the most common solid kidney tumor. Contrast-enhanced computed tomography (CT) is the most frequently used imaging modality in the diagnosis, staging, and evaluation of recurrence and treatment response in patients with RCC. The overall success rate of CT for these indications is reported to be between 61% and 91% (1,2,3). However, as RCCs may appear isodense, hypodense, or hyperdense, it is difficult to distinguish benign and malignant renal masses by morphological methods (4). Magnetic resonance imaging (MRI) is recommended in cases where CT is contraindicated, such as patients who have contrast allergy or are pregnant. However, MRI is no more accurate than CT. This increases the importance of positron emission tomography (PET), which enables metabolic evaluation in addition to visualizing anatomic changes. In this review, we discuss currently available literature data regarding the use of PET applications with different radiopharmaceuticals in patients with RCC. Applications of Positron Emission Tomography in Renal Cell Carcinoma 18-Fluorine-Fluorodeoxyglucose Positron Emission TomographyPET is a metabolic imaging method that utilizes various positron-emitting radiopharmaceutical and can provide data on many different metabolic pathways. The most widely used radiopharmaceutical is a fluorodeoxyglucose molecule (FDG) labeled with 18-fluorine (18F). The modality is based on the principle of visualizing elevated glycolysis and glucose uptake in neoplastic tissues. Despite high success rates in many solid organ malignancies, the use of 18F-FDG for urinary system malignancies is limited due to excretion via the urinary tract. The first cases related to the use of 18F-FDG PET in RCC were described by Wahl et al. (5) in the early 1990s. The use of 18F-FDG PET in the detection of primary RCC is especially controversial (6,7,8,9,10). High and variable levels of background renal activity make it difficult to detect the primary focus. Forced diuresis with hydration may increase the sensitivity Renal cell carcinoma is the most common solid kidney tumor. Conventional methods such as computed tomography and magnetic resonance imaging are usually chosen for diagnosis, staging, and evaluating recurrence and treatment response. However, the sensitivity of these methods is limited in each indication. For this reason, metabolic evaluation with positron emission tomography has an important value in most solid tumors. However, the role of 18-fluorine-fluorodeoxyglucose (18F-FDG), which is the most commonly used positron emission tomography (PET) radiopharmaceutical, is limited in the evaluation of primary kidney lesions due to urinary excretion. Therefore, new radiopharmaceuticals with no or limited urinary excretion have been developed. In this paper, the application of PET imaging with the widely used 18F-FDG and the newly developed fluorothymidine and gallium-68/18F prostate-specific membrane antigen in renal cell carcinoma are reviewed.

show abstract

Early Response Monitoring of Receptor Tyrosine Kinase Inhibitor Therapy in Metastatic Renal Cell Carcinoma Using [F-18]Fluorothymidine-Positron Emission Tomography-Magnetic Resonance

Cited by 5 publications

References 19 publications

¹⁸F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

¹⁸F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

Radiomics Analysis on FLT-PET/MRI for Characterization of Early Treatment Response in Renal Cell Carcinoma: A Proof-of-Concept Study

Positron Emission Tomography in Renal Cell Carcinoma

Contact Info

Product

Resources

About

Early Response Monitoring of Receptor Tyrosine Kinase Inhibitor Therapy in Metastatic Renal Cell Carcinoma Using [F-18]Fluorothymidine-Positron Emission Tomography-Magnetic Resonance

Cited by 5 publications

References 19 publications

18F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

18F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

Radiomics Analysis on FLT-PET/MRI for Characterization of Early Treatment Response in Renal Cell Carcinoma: A Proof-of-Concept Study

Positron Emission Tomography in Renal Cell Carcinoma

Contact Info

Product

Resources

About

¹⁸F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer

¹⁸F-FDG PET/CT for Monitoring of Treatment Response in Breast Cancer